Analysis of failure patterns and survival after SBRT for 147 cases of T 1-2N 0M 0 stage non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.

Failure mode and long-term survival after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Effects of robotic and laparoscopic-assisted surgery on lymph node dissection and short-term outcomes in patients with Siewert II adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

OBJECTIVE@#To compare the effects of robotic and laparoscopic-assisted radical total gastrectomy on lymph node dissection and short-term outcomes in patients with Siewert type II adenocarcinoma of esophagogastric junction (AEG).@*METHODS@#Inclusion criteria: the tumor center was located between 2 cm above and below the esophagogastric junction and was confirmed as adenocarcinoma by endoscopic biopsy.@*EXCLUSION CRITERIA@#tumor with local invasion of the liver,spleen, pancreas or other organs; intraoperative finding of tumor dissemination or distant metastasis; patients undergoing palliative surgical treatment or preoperative neoadjuvant chemotherapy; patients with serious heart diseases, lung diseases, liver diseases, kidney diseases and other comorbidities; patients with multiple primary cancers;patients receiving emergency surgery. According to the above criteria, 82 patients with Siewert type II AEG who underwent gastrointestinal surgery at the Affiliated Hospital of Qingdao University from October 2014 to October 2018 were enrolled in the study. They were randomly divided into robotic surgery groups (41 cases) and laparoscopic group (41 cases) according to a computer-generated randomized allocation table. Both groups underwent radical total gastrectomy plus D2 lymph node dissection through the transabdominal esophageal hiatus approach. The intraoperative conditions and postoperative short-term outcomes were compared between two groups, including surgery time, intraoperative blood loss, length of esophagectomy, postoperative complications, postoperative gastrointestinal recovery time, length of hospital stay, postoperative unplanned reoperation rate and rehospitalization rate. Mean±SD is used for the measurement data that conforms to the normal distribution, and two independent sample t-tests are used to compare the two groups; the comparison of the count data is performed by the χ² test.@*RESULTS@#There were 35 males (85.4%) with age of (62.3±10.0) years and body mass index of (24.4±3.2) kg/m² in the robotic surgery group. There were 37 males (90.2%) with age of (62.5±10.0) years and body mass index of (23.8±2.6) kg/m² in the laparoscopic group. No significant differences in the baseline data between two groups were found (all P>0.05). All the patients of both groups completed R0 resection successfully without conversion to laparotomy or perioperative death. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss [(70.7±39.9) ml vs. (110.2±70.6) ml, t=3.118, P=0.003], longer resected esophagus [(3.0±0.7) cm vs. (1.9±0.5) cm, t=8.759, P0.05). The highest lymph node metastasis rate was approximately 20% and observed in No.1, No.2, No.3, and No.7, followed by No.8a, No.9, No.11p, and No.110 with around 5%. The lymph node metastasis rate in other stations (No.4sa, No.4sb, No.4d, No.5, No.6, No.11d, No.12a, No.19, No.20 and No.111) was less than 5%.There were no significant differences in postoperative complication rate, postoperative fever time, postoperative exhaust and defecation time, fluid diet time, and postoperative hospital stay (all P>0.05). There were 2 patients(4.9%) with unplanned reoperation and 1 patient (2.4%) with unplanned re-admission in the laparoscopic group,while 3 patients (7.3%)with unplanned reoperation and 2 patients (4.9%)with unplanned re-admission in the robotic surgery group, whose differences were also not statistically significant (χ²=0.240,P=0.675;χ²=0.346,P=1.000).@*CONCLUSION@#Robot-assisted radical total gastrectomy for Siewert II AEG is safe and feasible, which is characterized by more sophisticated operation, less blood loss and higher quality of lymph node dissection, especially for subphrenic and inferior mediastinal lymph nodes.

Clinicopathological characteristics and prognosis analysis of 217 patients with carcinoma in the remnant stomach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological features and prognostic factors of carcinoma in the remnant stomach (CRS).</p><p><b>METHODS</b>Clinicopathological data of 217 consecutive CRS patients from January 2000 to March 2017 at Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University were retrospectively analyzed. CRS was defined as the primary cancer arising from the remnant stomach following gastrectomy, regardless of the initial disease or operation, and at no special time interval. The clinicopathological features and treatment were compared between CRS after benign disease operation (CRS-B) group and CRS after gastric cancer operation (CRS-C) group, and factors influencing prognosis were analyzed using Cox regression model analysis.</p><p><b>RESULTS</b>Of 217 patients, 189 were male and 28 were female with mean age of (60.9±11.2) years. The interval between the first and the second operations was (18.3±15.1) years. The CRS-B group comprised 108 patients and the CRS-C group comprised 109 patients. Compared to CRS-C group, CRS=B group had higher ratio of male [92.6% (100/108) vs. 81.7% (89/109), χ=5.779, P=0.016], longer interval [30(25-40) years vs. 4(1.5-8.0) years, Z=-1.685, P=0.000], longer tumor diameter [(5.9±3.2) cm vs. (3.9±2.4) cm, t=3.390, P=0.000] and later tumor stage [patients in stage I(, II(, III(, and IIII(: 6 (8.0%), 14 (18.7%), 41 (54.7%), and 14 (18.7%) vs. 16 (25.4%), 14 (22.2%), 21(33.3%), and 12(19.0%), respectively, Z=-2.018, P=0.044]. A total of 138 patients underwent surgery, including 118(85.5%) patients of curative resection and 20(14.5%) patients of palliative resection. The other 79 patients did not receive surgery due to extensive metastasis or miscellaneous reasons. Among 138 patients receiving surgery, 3 patients underwent endoscopic resection, 6 patients underwent minimally invasive surgery (laparoscopy or robot), and 129 patients underwent laparotomy. Forty-eight patients underwent surgery involving combined resection. The median postoperative hospital stay was 10(8-14) days. The incidence of postoperative complication was 23.2%(32/138). A total of 91 patients were followed up for 7-120 months, including 51 patients in CRS-B group and 40 in CRS-C group. The overall 1-, 3-, and 5-year survival rates of the 75 patients receiving curative resection were 80.7%, 55.1%, and 41.6%, respectively. The overall 1-, 3-, and 5-year survival rates were 73.5%, 48.3%, and 29.0% respectively in CRS-B group and 83.1%, 51.2%, and 32.5% respectively in CRS-C group. There was no significant difference between two groups (P=0.527). Multivariate analysis showed that age (RR=1.879, 95%CI: 1.015-3.479, P=0.045), radical procedure (RR=2.956, 95%CI: 1.421-6.150, P=0.004) and TNM stage (RR=1.570, 95%CI: 1.047-2.354, P=0.029) were independent prognostic factors for CRS.</p><p><b>CONCLUSIONS</b>As compared to the CRS-C group, the CRS-B group has higher percentage of male, longer interval, larger tumor diameter and later TNM stage. Radical resection indicates better prognosis.</p>

The effect of docosahexaenoic acid combined with cyclooxygenase-2 selective inhibitor NS-398 on the apoptosis of bile duct cancer cells QBC939 / 中华肝胆外科杂志

Objective To investigate the effect of docosahexaenoic acid (DHA) combined with cyclooxygenase-2 (COX-2) selective inhibitor NS-398 on the apoptosis of cholangiocarcinoma QBC939 cells and the mechanism.Methods In vitro,cholangiocarcinoma QBC939 cells were treated with 0,15,30,45,60 and 75 μg/ml DHA with 0,25,50,100,150 and 200 μmol/L NS-398,respectively.The absorbances of the QBC939 cells were measured by CCK8 and its growth inhibition ratios were analyzed.Flow cytometry was applied to detect cell apoptosis.The level of β-catenin and COX-2 mRNA and protein were measured by real-time PCR,immunocytochemistry and enzyme-linked immunoadsordent assay,respectively.Results DHA combined with NS-398 could significantly suppress the growth of QBC939 cells (P ＜ 0.05).When the concentration of DHA went up to 45 μg/ml and NS-398 was 100 μmol/L,the relative growth inhibition rate of QBC939 cells was 90.0％.If the concentrations were increased,the result showed no significant differences.Furthermore,flow cytometry analysis indicated that DHA combined with NS-398 could induce QBC939 cells apoptosis at the early stage,and the apoptosis rate was significantly different between the experimental and control groups (P ＜ 0.01).Real-time PCR showed low β-catenin and COX-2 expression in QBC939 cells disposed by DHA combined with NS-398,and their expression were significantly different between the experimental and control groups (P ＜ 0.01).Immunocytochemistry and ELISA demonstrated that DHA combined with NS-398 could decrease β-catenin and COX-2 protein expression in QBC939 cells.Conclusion DHA combined with NS-398 induced apoptosis and inhibited proliferation of cholangiocarcinoma cells QBC939 in vitro through targeting β-catenin and COX-2.

Prehospital delay and its influencing factors in acute ischemic stroke in Fuxin area / 国际脑血管病杂志

Objective To investigate Prehospital delay and its influencing factors in acute ischemic stroke in Fuxin area.Methods Consecutive patients with acute ischemic stroke admitted from March 1,2015 to July 1,2017 were enrolled prospectively.The patients were grouped by the cutoff value from onset to admission time ≤3 h.The demographic data,vascular risk factors,onset to admission time,and clinical data were recorded.Multivariate logistic regression analysis was used to identify the independent influencing factors of prehospital delay.Results A total of 758 patients were enrolled,including 123 (16.2％) from the onset to the admission time ≤3 h.Multivariatelogistic regression analysis showed that women (odds ratio,[OR] 14.782,95％ confidence interval [CI] 2.378-91.809;P=0.004),Mongolian (OR 6.218,95％ CI 1.642-23.520;P=0.008),low level of education (0-6 years:OR 5.047,95％ CI 1.306-19.519;P=0.023),place of residence (suburb or rural area:OR 4.024,95％ CI 1.080-14.987;P =0.038),low economic income (0-1500 yuan/month:OR 5.985,95％ CI 1.500-23.873;P =0.011),previous history of stroke/transient ischernic attack (OR 6.293,95％ CI 1.558-25.384;P=0.013),National Institutes of Health Stroke Scale score ≤8 (OR 12.352,95％ CI3.239-47.119;P＜0.001),limb weakness (OR 3.335,95％ CI 1.043-10.658;P=0.042) and dizziness (OR 7.031,95％ CI 1.814-14.027;P=0.005) as the initial symptom,transportation means (non-120 ambulances,private cars or taxis:OR 1.929,95％ CI 1.106-3.366;P =0.021),transferred from other hospital (OR 1.761,95％ CI 1.011-3.067;P=0.045),and first visit hospitals as health centers or primary hospitals (OR 1.811,95％ CI 1.034-3.173;P=0.037) were the independent factors of prehospital delay in patients with acute ischemic stroke.Conclusion Women,Mongolian,educational level,residence,economic income,history of stroke/transient ischemic attack,severity of illness,transportation initial,level of first visit hospital,and transfered from other hospital are the influencing factors for prehospital delay in patients with acute ischemic stroke in Fuxin area.

Expression and significance of Notch3, DLL1 and CD133 in colorectal adenocarcinoma / 重庆医学

Objective To investigate the expression of Notch3,DLL1 and CD133 in human colorectal adenocarcinoma and its clinical pathology meaning.Methods Immunohistochemical staining was used to detect the expression of Notch3,DLL1 and CD133 in 12 cases of normal colorectal mucosa tissue,30 cases of colorectal adenoma tissue and 50 cases of colorectal adenocarcinoma tissue,and the relationship between them and clinicopathological data wereanalyzed.Results The positive rates of Notch3,DLL1 and CD133 were 64.0 ％ (32/50),68.0 ％ (34/50) and 54.0 ％ (27/50) in colorectal carcinoma tissues,respectively,which were remarkably higher than those in colorectal adenoma tissue(26.7 ％,33.3％％,36.7 ％)and those in normal colorectal mucosa tissue (8.3％,16.7％,8.3％) (P＜0.05).There was no significant difference between the adenoma group and the normal group(P＞0.05).The expression levels of Notch3,DLL1 and CD133 were not correlated to age,gender,tumor location,degree of differentiation and the tumor size,except lymph node metastasis,in addition,the expression of Notch3 and DLL1 were also associated with Dukes staging,and The expression of DLL1 were also associated with tumor infiltration depth (P＜0.05).The expression of Notch3 protein was positively related to that of DLL1 protein(r=0.478,P=0.000).Conclusion The positive expression rates of Notch3,DLL1 and CD133 in colorectal adenocarcinoma tissue are remarkably higher than those in the normal colorectal mucosa and colorectal adenoma tissue,which prompts that the high expression of Notch3,DLL1 and CD133 may all participate in the process and metastasis of colorectal adenocarcinoma.Moreover Notch3 signalling pathway may act through the cancer stem cells and eventually regulate the initiation and development of colorectal adenocarcinoma.

Clinical efficacy of Fox surgery, improved Fox surgery and modified orbicularis oculi muscle fold surgery for the patients of entropion / 中华医学美学美容杂志

Objective To analyze the clinical efficacy of patients with lower eyelid entropion after the treatment of Fox surgery,modified Fox surgery and modified orbicularis oculi muscle fold surgery.Methods 250 patients with lower eyelid entropion were retrospectively analyzed.The modified orbicularis oculi muscle fold surgery (group A),Fox surgery (group B),and modified Fox surgery (group C) were used for lower eyelid entropion.Results Postoperatively,No skin redness and swelling occured in group A,and mild skin redness appeared in 8 and 2 cases in groups B and C,respectively;the difference was statistically significant between the three groups (P＜0.05);No eyelid hyperemia was found in groups A and C,but 6 cases presented with eyelid margin hyperemia in group B;the difference was statistically significant between the three groups (P ＜ 0.05).Long term follow-up showed that the satisfaction score of group A was (8.23±1.08),B group was (7.54±1.09),C group was (9.26± 1.94),and the difference between three groups was statistically significant (P＜0.05).In addition,the long-term recurrence rate showed that the recurrence rate in group C was the lowest,followed by group A,and the recurrence rate in group B was the highest,and the differences between various groups were statistically significant (P＜0.05).Conclusions The improved Fox surgery has better satisfaction and lower recurrence rate in patients with lower eyelid entropion,and especially the long-term effect is more definite.

The influence of NS-398 combined with DHA on the apoptosis of bile duct cancer cells QBC939 through inhibiting β-catenin and c-myc / 中华普通外科杂志

Objective To investigate the effect of NS-398 combined with docosahexaenoic acid (DHA) on apoptosis of cholangiocarcinoma QBC939 cells and its mechanism.Methods In vitro,cultured cholangiocarcinoma QBC939 cells were exposed to 0,25,50,100,150 and 200 μmol/L NS-398 with 0,15,30,45,60 and 75 μg/ml DHA respectively.The absorbance of the QBC939 cells were measured by CCK8 and its growth inhibition ratio were calculated.Flow cytometry was applied to detect cell apoptosis.The level of β-catenin and c-myc mRNA and protein were measured by real-time PCR,Western blot and enzyme-linked immunoabsordent assay respectively.Results Exposure to NS-398 combined with DHA suppressed the growth of QBC939 cells.When NS-398 was at 100 μmol/L and DHA at 45 pμg/ml,the relative growth inhibition rate of QBC939 cells was 90％ (F =5.85,P ＜ 0.05).NS-398 combined with DHA promoted QBC939 cells apoptosis at the early stage (F =8.16,P ＜ 0.01).Real-time PCR could detect low β-catenin and c-myc expression in QBC939 cells disposed by NS-398 combined with DHA (F =7.61,P ＜0.01),(F =7.92,P ＜0.01).NS-398 combined with DHA decreased β-catenin (F =7.75,P ＜ 0.01),(F=8.17,P＜0.01) and c-myc (F=8.76,P＜0.01),(F=8.12,P＜0.01) protein expression in QBC939 cells.Conclusion NS-398 combined with DHA promoted apoptosis and inhibit proliferation of cholangiocarcinoma cells QBC939 in vitro possibly through downregulated mRNA and protein expression of β-catenin and c-myc.

Current status and research progress of choroidal metastasis of lung cancer in China / 中华胸心血管外科杂志

Objective Choroidal metastasis of lung cancer is rare in clinical,it is easy to missed diagnosis or misdiagnosis,special research and discussion are not much.This article searched and reviewed associated literature and summarized the morbidity status,clinical characteristics,diagnosis and treatment of research progress of choroidal metastasis of lung cancer in China.It is expected to attract the attention of thoracic surgeons and help to early diagnose and rational treatment for improve the quality of life and prolong the life period.

Risk factors for death within 30 d after acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the risk factors for death within 30 d after onset in patients with acute ischemic stroke.Methods Consecutive inpatients with acute ischemic stroke were prospectively enrolled.The onset to admission time,baseline clinical characteristics,past history,routine laboratory results,and neuroimaging data of the patients were collected.Taking death within 30 d after the onset as primary outcome,they were divided into a death group and a survival group.The multivariate logistic regression analysis was used to determine the independent risk factors for death.Results A total of 758 patients were enrolled in the study,including 47 (6.2％) deaths.The mortality rate increased gradually with age (P ＜ 0.01).Multivariatelogistic regression analysis showed that male (odds ratio [OR]4.291,95％ confidence interval [CI] 1.560-11.791;P =0.005),age ＞ 80 years (OR 2.440,95％ CI 1.216-4.859;P=0.011),atrial fibrillation (OR 2.394,95％ CI 1.032-5.545;P =0.042),onset to admission time ＞3 h (OR 2.110,95％ CI 1.024-4.350;P =0.043),body temperature ＞37.4 ℃ at admission (OR 2.334,95％ CI 1.122-4.860;P =0.023),oxygen saturation ≤94％ (OR 17.125,95％ CI 2.873-102.162;P =0.001),baseline National Institutes of Health Stroke Scale score ＞ 15 (OR 8.411,95％ CI 2.263-31.287;P =0.003),baseline Glasgow Coma Scale score ＜3 (OR 16.490,95％ CI 2.821-96.444;P =0.005),white blood cell count ＞ 10 × 109/L (OR 2.115,95％ CI 1.042-4.291;P=0.038),complicated with pulmonary infection (OR 8.154,95％ CI 1.818-36.611;P=0.006),and cerebrocardiac syndrome (OR 2.667,95％ CI 1.055-6.740;P =0.038) were the independent risk factors for death within 30 d.Conclusion Male,advanced age,onset to admission time ＞ 3 h,body temperature ＞ 37.4 ℃ at admission,hypoxia,elevated white blood cell cotmt,as well as complicated with pulmonary infection after stroke,and cerebrocardiac syndrome were the independent risk factors for death within 30 d in patients with acute ischemic stroke.

Mechanism of Oridonin-induced Apoptosis of Glioma SHG44 Cells / 中国医科大学学报

Objective To study the molecular mechanism of oridonin-induced apoptosis of ghoma SHG44 cells.Methods A growth curve was plotted using CCK-8 colorimetric method with different concentrations of oridonin (0,1.25,2.5,5,10,20,and 40 μmol/L)to observe its effect on the growth of SHG44 cells.Hoechst33258 and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were used to examine the changes in cell morphology and flow cytometry was used to detect cell apoptosis.Western blotting was used to analyze the expression of apoptosis-related proteins (Caspase-3,cleaved Caspase-3,Bax,and Bcl-2)in SHG44 cells.Results SHG44 cell proliferation was significantly suppressed after 24 and 48 h Oridonin treatment,with a half-maximal inhibitory concentration of 7.865 and 4.74 μmol/L,respectively.Hoechst33258 and TUNEL staining showed changes in cell morphology such as shrinkage and nucleus fragmentation and morphogenesis,which are indicative of apoptosis.Western blotting analysis showed that oridonin inhibited the expression of Bcl-2 and activated the expression of Caspase-3 and Bax.Conclusion Oridonin can inhibit the proliferation and induce the apoptosis of SHG44 cells by regulating the expression of apoptosis-related proteins.

Atrial fibrillation and silent cerebral infarction / 国际脑血管病杂志

Silent cerebral infarction is widely exist in the elderly population.It is considered to be the early clinical stage of symptomatic stroke and cognitive impairment.The incidences of silent cerebral infarction are higher in patients with atrial fibrillation and after atrial fibrillation ablation.It is not clear whether anticoagulant therapy can prevent silent cerebral infarction and improve cognitive function in patients with atrial fibrillation.This article reviews the hot issues related to silent cerebral infarction and atrial fibrillation.

Impact and quality of life of minimally invasive surgery combined with catheter attract for patients with cere-bral hemorrhage / 局解手术学杂志

Objective To analyze the impact and quality of life of minimally invasive surgery combined with catheter attract surgery on patients with cerebral hemorrhage.Methods A total of 90 patients with cerebral hemorrhage in our department from February 2013 to De-cember 2014 were randomly divided into invasive group and the control group.Minimally invasive surgery group were given to cerebral hemor-rhage minimally invasive surgery combined with catheter attract surgery,the control group received traditional craniotomy.The postoperative recovery,nerve function scores,quality of life and morbidity between two groups were compared.Results The operation time and edema vol-ume of tissue postoperative 7 days in minimally invasive surgery group was significantly lower than those of the control group.The hematoma clearance rate 1 day after surgery was higher than that of control group,with statistically significant difference(P <0.05).NIHSS scores of two groups were gradually decreased 7 d,15 d,30 d after surgery(P <0.05).NIHSS scores of the minimally invasive surgery group 7 d,15 d, 30 d after surgery were lower than that of control group,with statistically significant difference(P <0.05).The scores of vitality,physiological function,physical function,general health,bodily pain,emotional function,social function,mental health after 6 months of the surgery in the min-imally invasive group was higher than those of control group,with statistically significant difference(P <0.05).The rate of postoperative pulmo-nary infection,electrolyte imbalance,gastrointestinal bleeding in MIS group were lower than those in the control group,with statistically signifi-cant difference(χ2 =5.400 0,4.405 7,4.615 4,P <0.05).Conclusion Minimally invasive surgery combined with catheter attract surgery can improve neurological function and quality of life for patients with intracerebral hemorrhage, and reduce the incidence of complications.

Sex difference in stroke / 国际脑血管病杂志

The sex difference in stroke is increasingly receiving attention. The incidence and prevalence of stroke in males are higher than in females. There are greater differences both among the age groups and populations. The incidences of cerebral infarction and intracerebral hemorrhage in males are higher than females, while the incidence of subarachnoidal hemorrhage is even higher in females. Studies have shown that mortality of stroke in males is higher; however,because the females are older and have more serious symptoms at the onset of stroke, therefore their prognosis is poorer. Poststroke depression is common in females and their quality of life is lower. Stroke in females is mostly involved in cerebral cortex; their atypical symptoms are more common. Both males and females can benefit from thrombolytic and stroke unit therapies. Females with cardioembolic stroke may benefit more from anticoagulant therapy.

Inhibiting ERK1/2 pathway reduces brain edema and down-regulates matrix metalloproteinase-9 expression after subarachnoid hemorrhage in rats / 国际脑血管病杂志

Objective To study the effect of extracellular signal-regulated kinase1/2 (ERK1/2)inhibitor U0126 on matrix metalloproteinase-9(MMP-9)in brain tissue after subarachnoid hemorrhage(SAH)in rats and to investigate the action mechanisms of ERK1/2 and M M P-9 in blood-brain barrier(BBB)injury and brain edema after SAH.Methods Seventy-two male Sprague-Dawley rats were randomly divided into four groups:SAH model,sham operation,U0126 intervention,and vehicle groups.A SAH model was induced by injection of autologous blood into cisterna magna once.The dry-wet weight method was used to detected brain tissue water content in order to evaluate cerebral edema.BBB permeability was evaluated by the Evans blue extravasation method.The immunohistochemical method was used to detect the expression of MMP-9 and phosphorylated ERK1/2.Results The expression of phosphorylated ERK1/2 and MMP-9 was lower in the sham operation group.The expression of both was up regulated at 24 hours after SAH.The brain water content and Evans blue content also increased.U0126 treatment decreased the phosphorylation of ERK1/2 and the expression of MMP-9,improved the BBB permeability,and alleviated brain edema.Conclusions MMP-9 is involved in the pathophysiological processes of early BBB injury and brain edema aft er SAH.ERK1/2 pathway may play a vital role in the expression of MMP-9.U0126 may protect BBB and reduce brain edema after SAH by inhibiting the phosphorylation of ERK1/2.

A study of mesenchymal stem cells decreasing intestinal permeability induced by mesenteric ischemia/reperfusion / 肠外与肠内营养

Objective: To investigate the effect of bone marrow mesenchymal stem cells (MSC) on the variation of intestinal permeability damaged by superior mesenteric artery ischemia and reperfusion. Methods: Bone marrow mesenchymal stem cells were isolated from cavity of tibias and femurs of male Sprague Dawley rat in a sterile condition, and were cultured and proliferated in plastic dishes. 10 week old female Sprague Dawley rats were randomly divided into three groups:group A (sham group), group B (MSC group) and group C (saline group). In group B and group C, the superior mesenteric artery (SMA) of the animals were seperated and occluded by non-invasive vascular clamp for 45 minutes. Immediately after removing the vascular clamp,1×10~7 MSC suspended in 0.5 ml sterile L-DMEM and the same volume of normal saline was submucosally injected into the small intestine at ten different points in group B and group C, respectively. In group A, the animals were only underwent laparotomy without clamping the SMA. 3 days and 6 days after the operation, 100 mg lactulose and 50mg mannitol dissolved in 2 ml distilled water were administrated by oral gavage and urine during 6 h experiment was collected for assaying the L/M ratio before sacrificing the animals. The donor derived MSC was identified by Y chromosome in situ hybridization in ileum tissue, and the serum D-lactate level was determined. Results: The donor derived MSC could home to the ischemia/reperfusion injured intestinal mucosa, and the intestinal permeability was much lower in group B (MSC group) than that in group C (saline group)(P<0.05). Conclusion: Mesenchymal stem cells can reduce the small intestinal mucosal permeability impaired by ischemia/reperfusion, and can participate in the preservation of integrity of the damaged gut mucosal mechanical barrier.

Induction of apoptosis and inhibition of proliferation of C6 glioma cells in vitro by tamoxifen / 药物分析学报

Objective To investigate the anti-tumor effect and mechanism of tamoxifen on rat C6 glioma cells. Methods C6 cells were cultured in Dulbecco's modified Eagle's medium (DMEM) with 3% fetal calf serum (FCS), and treated with tamoxifen of different concentrations, i.e. group A (1.25μmol/L), group B (2.50 μmol/L), group C (5.00 μmol/L), group D (10.00 μmol/L), group E (20.00 μmol/L) and control group (0.00 μmol/L). Morphological changes, MTT assay and 5-bromo-2'-deoxyuriding labeling ratio were assessed. Apoptosis was observed by flow cytometry. Results C6 cells treated with different doses of tamoxifen for 24, 48, and 72 hours became irregular in shape, while cells treated with vehicle grew normally. MTT assay showed that tamoxifen did not suppress C6 cell growth until 72 hours after treatment. Seventy-two hours after treatment, there were significant differences in cell viable rate between group A versus groups C, D and E; so did group B versus group D as well as group E (P<0.05). BrdU incorporation assay indicated significant difference of BrdU labbled index (BrdU LI) among groups A, C, E and control group 48 hours after treatment (P<0.05). And the BrdU LI decreased with the increased concentration of tamoxifen. Flow cytometry (FCM) showed significant difference between treated group and control group at 24, 48, and 72 hours after treatment (P<0.05). Conclusion Tamoxifen significantly suppresses the growth of C6 glioma cells in a time- and dose-dependent manner. The mechanism of tamoxifen suppressing C6 glioma cells may be inhibiting proliferation and inducing apoptosis. Therefore, tamoxifen can be a candidate as a chemotherapy agent for glioma.

The repairative effect of bone marrow mesenchymal stem cells on ischemia-reperfusion injury / 肠外与肠内营养

Bone marrow mesenchymal stem cells(MSCs) are a sort of somatic stem cells deriving from the mesoderm.They are capable of self-renewing,differentiating into mesenchymal or non-mesenchymal tissues,anti-inflammatory,reducing oxidative stress and immunomodulatory.MSCs exert their protective effect on various tissues,especially the ischemia-reperfusion injured tissue.This review summarizes the repairative potential of MSCs on ischemia-reperfusion injury.